Get the free 4090 (Cont.) FORM CMS-2552-10 03-18 - Cost Report Data
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4090 (Cont.)FORM CMS2552100318HOSPITALBASED FHC IDENTIFICATION DATAPROVIDER CCN: COMPONENT CCN: PERIOD: FROM: TO: Date Certified 3V/I Decertification 4WORKSHEET S11 PART I HOSPITALIZED FHC IDENTIFICATION
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01
To fill out form 4090 cont cms-2552-10, follow these steps:
02
Start by entering the basic information of the organization, such as name, address, and contact details.
03
Provide details about the organization's Medicare provider number and any associated subsidiary organizations.
04
Fill in the financial information, including revenue, expenses, and balance sheets.
05
Include information about the organization's cost report periods and any changes that may have occurred.
06
Specify details about any leased facilities and related costs.
07
Provide information about any Medicare settlements or audit adjustments.
08
Complete the certification statement and sign the form as required.
09
Review the filled-out form for accuracy and completeness before submitting it.
Who needs 4090 cont form cms-2552-10?
01
Form 4090 cont cms-2552-10 is needed by healthcare organizations participating in the Medicare program.
02
This includes hospitals, skilled nursing facilities, home health agencies, and comprehensive outpatient rehabilitation facilities.
03
These organizations are required to submit this form to report their financial and cost information for reimbursement purposes.
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What is 4090 cont form cms-2552-10?
Form 4090 cont (cms-2552-10) is a cost report form used by hospitals to report their costs to Medicare.
Who is required to file 4090 cont form cms-2552-10?
Hospitals that receive Medicare reimbursements are required to file form 4090 cont (cms-2552-10).
How to fill out 4090 cont form cms-2552-10?
Form 4090 cont (cms-2552-10) should be filled out following the instructions provided by Medicare, including reporting all relevant cost information.
What is the purpose of 4090 cont form cms-2552-10?
The purpose of form 4090 cont (cms-2552-10) is to allow hospitals to report their costs to Medicare for reimbursement purposes.
What information must be reported on 4090 cont form cms-2552-10?
Form 4090 cont (cms-2552-10) requires hospitals to report various cost information, including expenses related to patient care, administration, and overhead.
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